As expected, I found the following information BBM:
"The use of the allegedly defective AI model, developed by NaviHealth and called "nH Predict,"
"The nH Predict model was developed by NaviHealth Inc, a Tennessee company acquired by UnitedHealth in 2020 for $2.5 billion, the lawsuit states."
"UnitedHealth Group has been deploying AI and ML applications at-scale for more than a decade. Currently, these efforts are focused on reducing administrative burdens and ensuring health care workers can focus on tasks they are uniquely qualified for."
"Coverage decisions are ultimately "based on CMS coverage criteria and the terms of the member's plan," Albright said, adding that the lawsuit "has no merit."
"Aaron Albright, a spokesperson for NaviHealth told CBS MoneyWatch that the AI-powered tool is not used to make coverage determinations but as "a guide to help [UnitedHealth] inform providers ... about what sort of assistance and care the patient may need."
"The plaintiffs are the families of Gene B. Lokken and Dale Henry Tetzloff, both now-deceased patients who were covered by a Medicare Advantage Plan policy provided by UnitedHealthcare. from at least November 2019 to 2023."
There may have been other things I wanted to point out but BT became CEO in 2021, a lot of the problems they are referring to were problems prior to him becoming CEO. They are actually problems that have always been around in the healthcare industry and are not specifically due to anything related to BT personally. The anger regarding the coverage decisions may as well be more about the CMS coverage criteria and terms of the member's plan. There are criteria involved in those determinations that are beyond UHC's control in the matter. I can't speak to details related to those particular lawsuits but when you are dealing with someone who is on Medicare and have a supplemental policy, the terms of that coverage is spelled out before any of the patient's experience these medical emergencies/situations. In all accounts of what I read in the articles, the AI tool is not "denying" claims/coverage.. it is being used for other functions related to the entire process. The named tool, was developed by NaviHealth, not BT... so again, I see people incorrectly stating online that he himself developed this horrible AI program TO DENY claims...which is completely false.
I completely understand the frustrations people experience with their medical insurance. I truly do, but it is NOT due to any one person, it is the entire healthcare industry practices of all involved that culminate into this horrendous problem. You have member s who defraud the insurance companies, you have physicians/facilites who are defrauding the insurance companies as well as the members, you have insurance policies which are set up based on state or federal laws ... The issue is much bigger than the CEO of one organization. Again, the anger directed at this man personally is insane to me and this shooter either hated him personally for some reason or wrongly views him as the entire face of UHC or the US Healthcare system.